title: The impact of posttraumatic stress disorder on impairment in the UK military at the time of the Iraq war.
abstract: The aims of this study were to assess: (1) the relationship between PTSD and impairment, (2) whether there is a threshold in the association of PTSD score and impairment, and (3) whether any of the PTSD criteria are more strongly associated with impairment. We studied 10,069 service personnel from a representative sample of the British Armed Forces to assess the effects of the Iraq war. Participants completed the PTSD checklist (PCL), the general health questionnaire-12 (GHQ-12), the alcohol use disorder identification test (AUDIT) and five questions to assess impairment. 78% of those with a PCL-score of 50 or more endorsed at least one impairment item in comparison to 27% of those with a score below 50. The odds ratio (OR) of impairment in the PCL group with a score of 50 or more was 16.7 (95% CI 12.9-21.6). There was an increasing risk of impairment with an increasing category of PCL-score without a noticeable threshold. For each PTSD subscale: intrusiveness, avoidance/numbing and hyper-arousal, divided into four score categories, there was an increased association with impairment, but the association of avoidance/numbing with impairment was the greatest and independent of the other two criteria (OR 7.2 (95% CI 4.8-10.9). Having a good relationship with a partner had minimal effect on the level of association between PTSD and impairment. Functional impairment is a serious problem for those with PTSD. The impairment is not confined to those with the highest PCL-score. Avoidance/numbing is the criterion which makes the greatest independent contribution to impairment.
authors.affiliation: King's Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, King's College London, Weston Education Centre, Cutcombe Road, London SE1 9RJ, UK. roberto.rona@iop.kcl.ac.uk
authors.forename: Roberto J
authors.initials: RJ
authors.lastname: Rona
authors.forename: Margaret
authors.initials: M
authors.lastname: Jones
authors.forename: Amy
authors.initials: A
authors.lastname: Iversen
authors.forename: Lisa
authors.initials: L
authors.lastname: Hull
authors.forename: Neil
authors.initials: N
authors.lastname: Greenberg
authors.forename: Nicola T
authors.initials: NT
authors.lastname: Fear
authors.forename: Matthew
authors.initials: M
authors.lastname: Hotopf
authors.forename: Simon
authors.initials: S
authors.lastname: Wessely
mesh_terms: D000437:Alcoholism / Q000175:diagnosis / Q000453:epidemiology; D015331:Cohort Studies; D003130:Combat Disorders / Q000175:diagnosis / Q000453:epidemiology; D015897:Comorbidity; D003907:Dexamethasone / Q000031:analogs & derivatives; D005260:Female; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D007398:Interpersonal Relations; D054542:Iraq War, 2003-2011; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology; D008603:Mental Health / Q000706:statistics & numerical data; D008889:Military Personnel / Q000706:statistics & numerical data*; D010549:Personal Satisfaction; D011788:Quality of Life; D012307:Risk Factors; D012918:Social Alienation; D012919:Social Behavior; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology
chemical_list: C079704:dexamethasone-21-sulfobenzoate; D003907:Dexamethasone